Perceptions of precision health approaches in hypertension management; a quality improvement study (Preprint)

2021 ◽  
Author(s):  
Juliana Baratta ◽  
Cati Brown-Johnson ◽  
Nadia Safaeinili ◽  
Lisa Goldman Rosas ◽  
Latha Palaniappan ◽  
...  
Keyword(s):  
Adult Population ◽  
Hybrid Approach ◽  
The United States ◽  
High Tech ◽  
Hypertension Management ◽  
Consensus Methods ◽  
Structured Interviews ◽  
Individualized Care ◽  
Clinic Efficiency ◽  
Precision Health

BACKGROUND Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the United States (US) adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs such as remote BP monitoring may improve hypertension management. OBJECTIVE The Stanford Precision Health pilot, Humanwide, aimed to leverage high-tech and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program’s acceptability, appropriateness, feasibility, and sustainability. METHODS We conducted semi-structured interviews with 16 patients and 15 providers to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity. RESULTS Ten patients and six providers mentioned hypertension in the context of Humanwide. These participants reported remote BP monitoring improving motivation, BP control, and clinic efficiency. Providers discussed feasibility challenges including time needed to analyze BP data and give individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased use of remote BP monitoring over time. CONCLUSIONS Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and providers, and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing EMR integration of BP measurements, and finding more user-friendly BP cuffs. CLINICALTRIAL n/a

scholarly journals Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254578
Author(s):  
Latasha Jennings ◽  
Carolina Fernández Branson ◽  
Andrea M. Maxwell ◽  
Tyler N. A. Winkelman ◽  
Rebecca J. Shlafer
Keyword(s):  
Criminal Justice ◽  
Health Care Providers ◽  
Continuity Of Care ◽  
Hybrid Approach ◽  
The United States ◽  
System Level ◽  
Care Providers ◽  
Structured Interviews ◽  
Criminal Justice Involvement ◽  
Care Plans

Background In 2016, over 11 million individuals were admitted to prisons and jails in the United States. Because the majority of these individuals will return to the community, addressing their health needs requires coordination between community and correctional health care providers. However, few systems exist to facilitate this process and little is known about how physicians perceive and manage these transitions. Objective The goal of this study was to characterize physicians’ views on transitions both into and out of incarceration and describe how knowledge of a patient’s criminal justice involvement impacts patient care plans. Methods Semi-structured interviews were conducted between October 2018 and May 2019 with physicians from three community clinics in Hennepin County, Minnesota. Team members used a hybrid approach of deductive and inductive coding, in which a priori codes were defined based on the interview guide while also allowing for data-driven codes to emerge. Results Four themes emerged related to physicians’ perceptions on continuity of care for patients with criminal justice involvement. Physicians identified disruptions in patient-physician relationships, barriers to accessing prescription medications, disruptions in insurance coverage, and problems with sharing medical records, as factors contributing to discontinuity of care for patients entering and exiting incarceration. These factors impacted patients differently depending on the direction of the transition. Conclusions Our findings identified four disruptions to continuity of care that physicians viewed as key barriers to successful transitions into and out of incarceration. These disruptions are unlikely to be effectively addressed at the provider level and will require system-level changes, which Medicaid and managed care organizations could play a leading role in developing.

Telemedicine for Patients with Inflammatory Bowel Disease (TELE-IBD) Clinical Trial: Qualitative Assessment of Participants’ Perceptions of the TELE-IBD Intervention (Preprint)

2019 ◽  
Author(s):  
Charlene C Quinn ◽  
Sarah Chard ◽  
Erin G Roth ◽  
J. Kevin Eckert ◽  
Katharine M Russman ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Disease Activity ◽  
Remote Monitoring ◽  
Standard Care ◽  
Disease Process ◽  
The United States ◽  
Qualitative Assessment ◽  
Structured Interviews ◽  
Treatment Groups ◽  
Inflammatory Bowel

BACKGROUND Inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, affects 1 to 3 million people in the United States. Telemedicine has shown promise in IBD. The objective of the parent study, TELE-IBD, was to compare disease activity and quality of life (QoL) in a one-year randomized clinical trial of IBD patients receiving telemedicine versus standard care. Treatment groups experienced improvements in disease activity and QoL but there was not significant differences between groups. Study adherence to the text-based intervention was less than the 80% of the targeted goal. OBJECTIVE To understand adherence to remote monitoring, the goal of this qualitative assessment was to obtain TELE-IBD trial participants’ perceptions of the TELE-IBD system, including their recommendations for future TELE-IBD monitoring. METHODS In the parent study, patients attending three tertiary referral centers with worsening IBD symptoms in the previous two years were eligible for randomization to remote monitoring via texts every other week (EOW), weekly (W) or standard care. Participants (n=348) were evenly enrolled in the treatment groups and 259 (74.4%) completed the study. For this study, a purposive sample of adherent (N=15) and non-adherent (N=14) patients was drawn from the TELE-IBD trial population. Adherence was defined as the completion of 80% or more of the W or EOW self-assessments. Semi-structured interviews conducted by phone surveyed 1) the strengths and benefits of TELE-IBD; 2) challenges associated with using TELE-IBD; and 3) how to improve the TELE-IBD intervention. Interviews were recorded, professionally transcribed, and coded based on a priori concepts and emergent themes with the aid of ATLAS.ti qualitative data analysis software. RESULTS Participants' discussions centered on three elements of the intervention: 1) self-assessment questions, 2) action plans, and 3) educational messages. Participants also commented on: text-based platform, depression and adherence, TELE-IBD system in place of office visit, and their recommendations for future TELE-IBD systems. Adherent and non-adherent participants prefer a flexible system that is personalized, including targeted education messages, and they perceive TELE-IBD as effective in facilitating IBD self-management. CONCLUSIONS Participants identified clear benefits to the TELE-IBD system, including obtaining a better understanding of the disease process, monitoring their symptoms, and feeling connected to their health care provider. Participants' perceptions obtained in this qualitative study will assist in improving the TELE-IBD system to be more responsive to patients with IBD. CLINICALTRIAL NCT01692743

Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

2020 ◽  
Author(s):  
Sissel Ravn ◽  
Henriette Vind Thaysen ◽  
Lene Seibaek ◽  
Victor Jilbert Verwaal ◽  
Lene Hjerrild Iversen
Keyword(s):  
Ct Scan ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Structured Interviews ◽  
European Organization ◽  
Individualized Care ◽  
Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

2020 ◽  
Author(s):  
Ruoyan Sun ◽  
Henna Budhwani
Keyword(s):  
Public Health ◽  
United States ◽  
Cumulative Incidence ◽  
Hot Spots ◽  
Adult Population ◽  
State Level ◽  
The United States ◽  
Education Attainment ◽  
Public Health Systems ◽  
Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

scholarly journals Male autistic youth experiences of belonging in integrated physical education

Autism ◽  
2021 ◽  
pp. 136236132110186
Author(s):  
Justin A Haegele ◽  
Anthony J Maher
Keyword(s):  
Physical Education ◽  
Peer Relationships ◽  
Peer Interactions ◽  
Physical Space ◽  
The United States ◽  
Educational Needs ◽  
Subjective Experiences ◽  
Structured Interviews ◽  
Autistic People ◽  
Locker Room

The study examined the subjective experiences of autistic youth regarding the role of peer interactions and relationships in feelings of belonging in integrated physical education classes. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. Eight autistic youth (all male, aged 13–18 years) who had received most of their physical education in integrated classes acted as participants. Semi-structured interviews were used to generate qualitative data, which were analyzed using a reflexive thematic approach. Findings are presented in three themes: (a) bullying can lead to self-harm and self-isolation, (b) peer interactions and relationships in the locker room, and (c) peer relationships are based on shared interests and take time to develop. Even though autistic students were educated in the same spaces as their non-autistic peers, feelings of belonging were largely unavailable to them. Lay abstract Recent years have seen calls to amplify the voices of autistic people in research about their subjective experiences. Despite this, we know little about how autistic youth experience integrated physical education, particularly in the United States. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. In this study, we sought to explore the perspectives of autistic youth toward their experiences in integrated physical education, and the roles of social interactions and relationships with peers in those experiences. Findings noted that several factors influenced the ways and extent to which our participants interacted with their peers during physical education. Unfortunately, most of our participants recalled experiencing bullying, and that physical education offered an environment where bullying was most frequent and comparatively unique compared to other contexts throughout the school day. The locker room, a space linked to physical education, was of particular concern because of a lack of teacher presence. Despite the negative views of and experiences in physical education, there was evidence of participants actively pursuing to connect with peers in this context. However, most instances where participants recalled pursuing friendship were not welcomed from others, which stunted their sense of belonging in this space. Given the role that belonging plays in what it means “to be included,” our research supports emerging ideas that even though autistic students were educated in the same physical spaces as their non-autistic peers, feelings of inclusion were largely absent.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

2021 ◽  
Author(s):  
Kyle Wilhelm ◽  
Lindsey Wilhelm
Keyword(s):  
Music Therapy ◽  
Private Practice ◽  
Phenomenological Study ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
The United States ◽  
Business Owners ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Music Therapists

Abstract As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs’ lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

The economic burden of vertigo and dizziness in the United States

2020 ◽  
pp. 1-10
Author(s):  
Jeremy S. Ruthberg ◽  
Chandruganesh Rasendran ◽  
Armine Kocharyan ◽  
Sarah E. Mowry ◽  
Todd D. Otteson
Keyword(s):  
United States ◽  
Health Care ◽  
Economic Burden ◽  
Clinical Characteristics ◽  
Care Service ◽  
Adult Population ◽  
Health Care Service ◽  
The United States ◽  
Medical Expenditures ◽  
Limited Information

BACKGROUND: Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE: Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS: A retrospective analysis of data from the Medical Expenditures Panel Survey (2007–2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS: Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007–2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p <  0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION: Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.

scholarly journals Responsibility for chemical exposures: perspectives from small beauty salons and auto shops in southern metropolitan Tucson

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda A. Lee ◽  
Maia Ingram ◽  
Carolina Quijada ◽  
Andres Yubeta ◽  
Imelda Cortez ◽  
...  
Keyword(s):  
Small Businesses ◽  
Chemical Exposure ◽  
The United States ◽  
Power Structures ◽  
Structured Interviews ◽  
Chemical Exposures ◽  
Study Partner ◽  
Chemical Products ◽  
Beauty Salons ◽  
Exposure Risks

Abstract Background Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of ‘responsibilization’ in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses. Methods We conducted semi-structured interviews with a total of 22 workers and owners in auto repair shops and beauty salons – two high-risk industries – in Southern Metropolitan Tucson. Participants were asked about their insights into workplace chemical exposures and health. A qualitative analysis team with representation from all study partner organizations collectively coded and reviewed the interview data in QSR International’s NVivo 11 and identified overarching themes across the interviews. Results We identified three primary themes: 1) ambivalence toward risks in the workplace; 2) shifting responsibilities for exposure protection at work; and 3) reflections on the system behind chemical exposure risks. Participants discussed the complexities that small businesses face in reducing chemical exposures. Conclusions Through our analysis of the interviews, we examine how neoliberal occupational and environmental policies funnel responsibility for controlling chemical exposures down to individuals in small businesses with limited resources, obscuring the power structures that maintain environmental health injustices. We conclude with a call for upstream policy changes that more effectively regulate and hold accountable the manufacturers of chemical products used daily by small business workers.

scholarly journals Balancing race, gender, and responsibility: Conversations with four black women in educational leadership in the United States of America

2021 ◽  
pp. 174114322199183
Author(s):  
Natasha N Johnson
Keyword(s):  
United States ◽  
Black Women ◽  
Educational Leadership ◽  
United States Of America ◽  
Hermeneutic Phenomenology ◽  
The United States ◽  
Women's Leadership ◽  
Structured Interviews ◽  
Race And Gender ◽  
And Gender

This article focuses on equitable leadership and its intersection with related yet distinct concepts salient to social justice pertinent to women and minorities in educational leadership. This piece is rooted and framed within the context of the United States of America, and the major concepts include identity, equity, and intersectionality—specific to the race-gender dyad—manifested within the realm of educational leadership. The objective is to examine theory and research in this area and to discuss the role they played in this study of the cultures of four Black women, all senior-level leaders within the realm of K-20 education in the United States. This work employed the tenets of hermeneutic phenomenology, focusing on the intersecting factors—race and gender, specifically—that impact these women’s ability and capability to perform within the educational sector. The utilization of in-depth, timed, semi-structured interviews allowed participants to reflect upon their experiences and perceptions as Black women who have navigated and continue to successfully navigate the highest levels of the educational leadership sphere. Contributors’ recounted stories of navigation within spaces in which they are underrepresented revealed the need for more research specific to the intricacies of Black women’s leadership journeys in the context of the United States.

scholarly journals An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care

2021 ◽  
pp. 104990912098612
Author(s):  
Alycia A. Bristol ◽  
Sobaata Chaudhry ◽  
Dana Assis ◽  
Rebecca Wright ◽  
Derek Moriyama ◽  
...  
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Stage Iv ◽  
The United States ◽  
Qualitative Description ◽  
Disease Stage ◽  
Structured Interviews ◽  
Care Clinic ◽  
Clinical Model

Objectives: The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. Methods: Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. Results: We identified 2 themes: “Communication addressing the emotional and physical aspects of disease” and “Filling gaps in care”; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. Significance of Results: Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.

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